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Published in: European Journal of Pediatrics 12/2015

01-12-2015 | Original Article

Intracranial hemorrhage and other symptoms in infants associated with human parechovirus in Vienna, Austria

Authors: Herbert Kurz, Ruth Prammer, Wolfgang Bock, Robert Ollerieth, Günther Bernert, Karl Zwiauer, Judith H. Aberle, Stephan W. Aberle, Tamas Fazekas, Wolfgang Holter

Published in: European Journal of Pediatrics | Issue 12/2015

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Abstract

The human parechovirus (HPeV), mainly genotype 3, may cause severe illness in young infants and neonates, including sepsis-like illness and central nervous system (CNS) infection. We lack data concerning the impact and symptoms of HPeV infection in infants in Austria. The aim of the study is to evaluate the spectrum of symptoms and findings in infants with the parechovirus in Vienna and its environs. Patients younger than 3 months of age, with clinically suspected sepsis-like illness or CNS infection and a positive polymerase chain reaction (PCR) for HPeV, were included in the study. Medical records were analyzed retrospectively. Twenty patients were included in the study from 2009 to 2013. The most frequent manifestations were fever and neurological symptoms (89 and 80 %, respectively). Fifty percent of the infants had white blood cell counts out of range. The most notable aspect was cerebral hemorrhage in three neonates, which has not been reported earlier in association with HPeV infection.
Conclusion: In Austria, HPeV is a relevant pathogen in sepsis-like disease in infants. The clinical presentation is similar to that described in other studies; cerebral hemorrhage is a new aspect.
What is Known:
Parechovirus infection can cause severe illness in infants.
Symptoms have been described to involve all organs; sepsis-like signs, fever, and irritability are most frequent.
What is New:
Also in Austria, HPeV plays an important role in severe illnesses in infants.
Severe intracranial hemorrhage is described as a new finding.
Literature
1.
go back to reference Aberle JH, Aberle SW, Pracher E, Hutter HP, Kundi M, Popow-Kraupp T (2005) Single versus dual respiratory virus infections in hospitalized infants: impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J 24(7):605–610CrossRefPubMed Aberle JH, Aberle SW, Pracher E, Hutter HP, Kundi M, Popow-Kraupp T (2005) Single versus dual respiratory virus infections in hospitalized infants: impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J 24(7):605–610CrossRefPubMed
2.
go back to reference Aberle SW, Puchhammer-Stockl E (2002) Diagnosis of herpesvirus infections of the central nervous system. J Clin Virol : Off Publ Pan Am Soc Clin Virol 25(Suppl 1):S79–85CrossRef Aberle SW, Puchhammer-Stockl E (2002) Diagnosis of herpesvirus infections of the central nervous system. J Clin Virol : Off Publ Pan Am Soc Clin Virol 25(Suppl 1):S79–85CrossRef
4.
go back to reference Baumgarte S, de Souza Luna LK, Grywna K, Panning M, Drexler JF, Karsten C, Huppertz HI, Drosten C (2008) Prevalence, types, and RNA concentrations of human parechoviruses, including a sixth parechovirus type, in stool samples from patients with acute enteritis. J Clin Microbiol 46(1):242–248. doi:10.1128/JCM.01468-07 PubMedCentralCrossRefPubMed Baumgarte S, de Souza Luna LK, Grywna K, Panning M, Drexler JF, Karsten C, Huppertz HI, Drosten C (2008) Prevalence, types, and RNA concentrations of human parechoviruses, including a sixth parechovirus type, in stool samples from patients with acute enteritis. J Clin Microbiol 46(1):242–248. doi:10.​1128/​JCM.​01468-07 PubMedCentralCrossRefPubMed
5.
go back to reference Benschop KS, Schinkel J, Minnaar RP, Pajkrt D, Spanjerberg L, Kraakman HC, Berkhout B, Zaaijer HL, Beld MG, Wolthers KC (2006) Human parechovirus infections in Dutch children and the association between serotype and disease severity. Clin Infect Dis : Off Publ Infect Dis Soc Am 42(2):204–210. doi:10.1086/498905 CrossRef Benschop KS, Schinkel J, Minnaar RP, Pajkrt D, Spanjerberg L, Kraakman HC, Berkhout B, Zaaijer HL, Beld MG, Wolthers KC (2006) Human parechovirus infections in Dutch children and the association between serotype and disease severity. Clin Infect Dis : Off Publ Infect Dis Soc Am 42(2):204–210. doi:10.​1086/​498905 CrossRef
7.
go back to reference Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB, Mutton KJ (2002) Development and evaluation of a ‘real-time’ RT-PCR for the detection of enterovirus and parechovirus RNA in CSF and throat swab samples. J Med Virol 67(4):555–562. doi:10.1002/jmv.10138 CrossRefPubMed Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB, Mutton KJ (2002) Development and evaluation of a ‘real-time’ RT-PCR for the detection of enterovirus and parechovirus RNA in CSF and throat swab samples. J Med Virol 67(4):555–562. doi:10.​1002/​jmv.​10138 CrossRefPubMed
10.
go back to reference Ghanem-Zoubi N, Shiner M, Shulman LM, Sofer D, Wolf D, Marva E, Kra-Oz Z, Shachor-Meyouhas Y, Averbuch D, Bechor-Fellner A, Barkai G, Kinarty A, Gershstein V, Ephros M (2013) Human parechovirus type 3 central nervous system infections in Israeli infants. J Clin Virol : Off Publ Pan Am Soc Clin Virol 58(1):205–210. doi:10.1016/j.jcv.2013.06.001 CrossRef Ghanem-Zoubi N, Shiner M, Shulman LM, Sofer D, Wolf D, Marva E, Kra-Oz Z, Shachor-Meyouhas Y, Averbuch D, Bechor-Fellner A, Barkai G, Kinarty A, Gershstein V, Ephros M (2013) Human parechovirus type 3 central nervous system infections in Israeli infants. J Clin Virol : Off Publ Pan Am Soc Clin Virol 58(1):205–210. doi:10.​1016/​j.​jcv.​2013.​06.​001 CrossRef
11.
go back to reference Gupta S, Fernandez D, Siddiqui A, Tong WC, Pohl K, Jungbluth H (2010) Extensive white matter abnormalities associated with neonatal parechovirus (HPeV) infection. Eur J Paediatr Neurol: EJPN : Off J Eur Paediatr Neurol Soc 14(6):531–534. doi:10.1016/j.ejpn.2009.12.007 CrossRef Gupta S, Fernandez D, Siddiqui A, Tong WC, Pohl K, Jungbluth H (2010) Extensive white matter abnormalities associated with neonatal parechovirus (HPeV) infection. Eur J Paediatr Neurol: EJPN : Off J Eur Paediatr Neurol Soc 14(6):531–534. doi:10.​1016/​j.​ejpn.​2009.​12.​007 CrossRef
13.
go back to reference Harvala H, McLeish N, Kondracka J, McIntyre CL, McWilliam Leitch EC, Templeton K, Simmonds P (2011) Comparison of human parechovirus and enterovirus detection frequencies in cerebrospinal fluid samples collected over a 5-year period in Edinburgh: HPeV type 3 identified as the most common picornavirus type. J Med Virol 83(5):889–896. doi:10.1002/jmv.22023 CrossRefPubMed Harvala H, McLeish N, Kondracka J, McIntyre CL, McWilliam Leitch EC, Templeton K, Simmonds P (2011) Comparison of human parechovirus and enterovirus detection frequencies in cerebrospinal fluid samples collected over a 5-year period in Edinburgh: HPeV type 3 identified as the most common picornavirus type. J Med Virol 83(5):889–896. doi:10.​1002/​jmv.​22023 CrossRefPubMed
16.
go back to reference Ito M, Yamashita T, Tsuzuki H, Takeda N, Sakae K (2004) Isolation and identification of a novel human parechovirus. J Gen Virol 85(Pt 2):391–398CrossRefPubMed Ito M, Yamashita T, Tsuzuki H, Takeda N, Sakae K (2004) Isolation and identification of a novel human parechovirus. J Gen Virol 85(Pt 2):391–398CrossRefPubMed
17.
go back to reference Jaaskelainen AJ, Kolehmainen P, Kallio-Kokko H, Nieminen T, Koskiniemi M, Tauriainen S, Lappalainen M (2013) First two cases of neonatal human parechovirus 4 infection with manifestation of suspected sepsis, Finland. J Clin Virol : Off Publ Pan Am Soc Clin Virol 58(1):328–330. doi:10.1016/j.jcv.2013.06.010 CrossRef Jaaskelainen AJ, Kolehmainen P, Kallio-Kokko H, Nieminen T, Koskiniemi M, Tauriainen S, Lappalainen M (2013) First two cases of neonatal human parechovirus 4 infection with manifestation of suspected sepsis, Finland. J Clin Virol : Off Publ Pan Am Soc Clin Virol 58(1):328–330. doi:10.​1016/​j.​jcv.​2013.​06.​010 CrossRef
18.
go back to reference Ljubin-Sternak S, Juretic E, Santak M, Plesa M, Forcic D, Vilibic-Cavlek T, Aleraj B, Mlinaric-Galinovic G (2011) Clinical and molecular characterization of a parechovirus type 1 outbreak in neonates in Croatia. J Med Virol 83(1):137–141. doi:10.1002/jmv.21848 CrossRefPubMed Ljubin-Sternak S, Juretic E, Santak M, Plesa M, Forcic D, Vilibic-Cavlek T, Aleraj B, Mlinaric-Galinovic G (2011) Clinical and molecular characterization of a parechovirus type 1 outbreak in neonates in Croatia. J Med Virol 83(1):137–141. doi:10.​1002/​jmv.​21848 CrossRefPubMed
19.
go back to reference Niesters HG (2004) Molecular and diagnostic clinical virology in real time. Clin Microbiol Infect : Off Publ Eur Soc Clin Microbiol Infect Dis 10(1):5–11CrossRef Niesters HG (2004) Molecular and diagnostic clinical virology in real time. Clin Microbiol Infect : Off Publ Eur Soc Clin Microbiol Infect Dis 10(1):5–11CrossRef
21.
go back to reference Piralla A, Furione M, Rovida F, Marchi A, Stronati M, Gerna G, Baldanti F (2012) Human parechovirus infections in patients admitted to hospital in Northern Italy, 2008-2010. J Med Virol 84(4):686–690. doi:10.1002/jmv.23197 CrossRefPubMed Piralla A, Furione M, Rovida F, Marchi A, Stronati M, Gerna G, Baldanti F (2012) Human parechovirus infections in patients admitted to hospital in Northern Italy, 2008-2010. J Med Virol 84(4):686–690. doi:10.​1002/​jmv.​23197 CrossRefPubMed
24.
25.
go back to reference Schuffenecker I, Javouhey E, Gillet Y, Kugener B, Billaud G, Floret D, Lina B, Morfin F (2012) Human parechovirus infections, Lyon, France, 2008-10: evidence for severe cases. J Clin Virol : Off Publ Pan Am Soc Clin Virol 54(4):337–341. doi:10.1016/j.jcv.2012.04.016 CrossRef Schuffenecker I, Javouhey E, Gillet Y, Kugener B, Billaud G, Floret D, Lina B, Morfin F (2012) Human parechovirus infections, Lyon, France, 2008-10: evidence for severe cases. J Clin Virol : Off Publ Pan Am Soc Clin Virol 54(4):337–341. doi:10.​1016/​j.​jcv.​2012.​04.​016 CrossRef
26.
go back to reference Sedmak G, Nix WA, Jentzen J, Haupt TE, Davis JP, Bhattacharyya S, Pallansch MA, Oberste MS (2010) Infant deaths associated with human parechovirus infection in Wisconsin. Clin Infect Dis : Off Publ Infect Dis Soc Am 50(3):357–361. doi:10.1086/649863 CrossRef Sedmak G, Nix WA, Jentzen J, Haupt TE, Davis JP, Bhattacharyya S, Pallansch MA, Oberste MS (2010) Infant deaths associated with human parechovirus infection in Wisconsin. Clin Infect Dis : Off Publ Infect Dis Soc Am 50(3):357–361. doi:10.​1086/​649863 CrossRef
28.
go back to reference Sharp J, Harrison CJ, Puckett K, Selvaraju SB, Penaranda S, Nix WA, Oberste MS, Selvarangan R (2013) Characteristics of young infants in whom human parechovirus, enterovirus or neither were detected in cerebrospinal fluid during sepsis evaluations. Pediatr Infect Dis J 32(3):213–216. doi:10.1097/INF.0b013e318276b328 PubMedCentralPubMed Sharp J, Harrison CJ, Puckett K, Selvaraju SB, Penaranda S, Nix WA, Oberste MS, Selvarangan R (2013) Characteristics of young infants in whom human parechovirus, enterovirus or neither were detected in cerebrospinal fluid during sepsis evaluations. Pediatr Infect Dis J 32(3):213–216. doi:10.​1097/​INF.​0b013e318276b328​ PubMedCentralPubMed
31.
go back to reference Tapia G, Cinek O, Witso E, Kulich M, Rasmussen T, Grinde B, Ronningen KS (2008) Longitudinal observation of parechovirus in stool samples from Norwegian infants. J Med Virol 80(10):1835–1842. doi:10.1002/jmv.21283 CrossRefPubMed Tapia G, Cinek O, Witso E, Kulich M, Rasmussen T, Grinde B, Ronningen KS (2008) Longitudinal observation of parechovirus in stool samples from Norwegian infants. J Med Virol 80(10):1835–1842. doi:10.​1002/​jmv.​21283 CrossRefPubMed
33.
go back to reference van der Sanden SM, Koopmans MP, van der Avoort HG (2013) Detection of human enteroviruses and parechoviruses as part of the national enterovirus surveillance in the Netherlands, 1996-2011. Eur J Clin Microbiol Infect Dis: Off Publ Eur Soc Clin Microbiol 32(12):1525–1531. doi:10.1007/s10096-013-1906-9 CrossRef van der Sanden SM, Koopmans MP, van der Avoort HG (2013) Detection of human enteroviruses and parechoviruses as part of the national enterovirus surveillance in the Netherlands, 1996-2011. Eur J Clin Microbiol Infect Dis: Off Publ Eur Soc Clin Microbiol 32(12):1525–1531. doi:10.​1007/​s10096-013-1906-9 CrossRef
35.
go back to reference Verboon-Maciolek MA, Groenendaal F, Hahn CD, Hellmann J, van Loon AM, Boivin G, de Vries LS (2008) Human parechovirus causes encephalitis with white matter injury in neonates. Ann Neurol 64(3):266–273. doi:10.1002/ana.21445 CrossRefPubMed Verboon-Maciolek MA, Groenendaal F, Hahn CD, Hellmann J, van Loon AM, Boivin G, de Vries LS (2008) Human parechovirus causes encephalitis with white matter injury in neonates. Ann Neurol 64(3):266–273. doi:10.​1002/​ana.​21445 CrossRefPubMed
37.
go back to reference Westerhuis B, Kolehmainen P, Benschop K, Nurminen N, Koen G, Koskiniemi M, Simell O, Knip M, Hyoty H, Wolthers K, Tauriainen S (2013) Human parechovirus seroprevalence in Finland and the Netherlands. J Clin Virol : Off Publ Pan Am Soc Clin Virol 58(1):211–215. doi:10.1016/j.jcv.2013.06.036 CrossRef Westerhuis B, Kolehmainen P, Benschop K, Nurminen N, Koen G, Koskiniemi M, Simell O, Knip M, Hyoty H, Wolthers K, Tauriainen S (2013) Human parechovirus seroprevalence in Finland and the Netherlands. J Clin Virol : Off Publ Pan Am Soc Clin Virol 58(1):211–215. doi:10.​1016/​j.​jcv.​2013.​06.​036 CrossRef
38.
go back to reference Wolthers KC, Benschop KS, Schinkel J, Molenkamp R, Bergevoet RM, Spijkerman IJ, Kraakman HC, Pajkrt D (2008) Human parechoviruses as an important viral cause of sepsis-like illness and meningitis in young children. Clin Infect Dis : Off Publ Infect Dis Soc Am 47(3):358–363. doi:10.1086/589752 CrossRef Wolthers KC, Benschop KS, Schinkel J, Molenkamp R, Bergevoet RM, Spijkerman IJ, Kraakman HC, Pajkrt D (2008) Human parechoviruses as an important viral cause of sepsis-like illness and meningitis in young children. Clin Infect Dis : Off Publ Infect Dis Soc Am 47(3):358–363. doi:10.​1086/​589752 CrossRef
39.
go back to reference Yuzurihara SS, Ao K, Hara T, Tanaka F, Mori M, Kikuchi N, Kai S, Yokota S (2013) Human parechovirus-3 infection in nine neonates and infants presenting symptoms of hemophagocytic lymphohistiocytosis. J Infect Chemother : Off J Jpn Soc Chemother 19(1):144–148. doi:10.1007/s10156-012-0420-9 CrossRef Yuzurihara SS, Ao K, Hara T, Tanaka F, Mori M, Kikuchi N, Kai S, Yokota S (2013) Human parechovirus-3 infection in nine neonates and infants presenting symptoms of hemophagocytic lymphohistiocytosis. J Infect Chemother : Off J Jpn Soc Chemother 19(1):144–148. doi:10.​1007/​s10156-012-0420-9 CrossRef
40.
go back to reference Zhong H, Lin Y, Su L, Cao L, Xu M, Xu J (2013) Prevalence of human parechoviruses in central nervous system infections in children: a retrospective study in Shanghai, China. J Med Virol 85(2):320–326. doi:10.1002/jmv.23449 CrossRefPubMed Zhong H, Lin Y, Su L, Cao L, Xu M, Xu J (2013) Prevalence of human parechoviruses in central nervous system infections in children: a retrospective study in Shanghai, China. J Med Virol 85(2):320–326. doi:10.​1002/​jmv.​23449 CrossRefPubMed
Metadata
Title
Intracranial hemorrhage and other symptoms in infants associated with human parechovirus in Vienna, Austria
Authors
Herbert Kurz
Ruth Prammer
Wolfgang Bock
Robert Ollerieth
Günther Bernert
Karl Zwiauer
Judith H. Aberle
Stephan W. Aberle
Tamas Fazekas
Wolfgang Holter
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 12/2015
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-015-2583-8

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